Is different better?: models of teaching and their influence on the net financial outcome for general practice teaching posts.

BACKGROUND: In Australia, training for general practice (GP) occurs within private practices and their involvement in teaching can have significant financial costs. At the same time there are growing demands for clinical places for all disciplines and for GP there is concern that there are insufficient teaching practices to meet the demand at the medical student, prevocational and vocational training levels. One option to address this may be to change how teaching occurs in the practice. A question that arises in posing such an option is whether different models of teaching change the costs for a teaching practice. The aim of this study is to determine the net financial outcome of teaching models in private GP. METHODS: Modelling the financial implications for a range of teaching options using a costing framework developed from a survey of teaching practices in South Australia. Each option was compared with the traditional model of teaching where one GP supervisor is singularly responsible for one learner. The main outcome measure was net financial outcome per week. Decisions on the model cost parameters were made by the study's Steering Group which comprised of experienced GP supervisors. Four teaching models are presented. Model 1 investigates the gains from teaching multiple same level learners, Models 2 and 3, the benefits of vertically integrated teaching using different permutations, and Model 4 the concept of a GP teacher who undertakes all the teaching. RESULTS: There was a significant increase in net benefits of Aus$547 per week (95% confidence intervals $459, $668) to the practice when a GP taught two same level learners (Model 1) and when a senior registrar participated in teaching a prevocational doctor (Model 3, Aus$263, 95% confidence intervals $80, $570). For Model 2, a practice could significantly reduce the loss if a registrar was involved in vertically integrated teaching which included the training of a medical student (Aus$551, 95% confidence intervals $419, $718). The GP teacher model resulted in a net remuneration of Aus$207,335 per year, sourced predominantly from the GP teacher activities, with no loss to the practice. CONCLUSIONS: Our study costed teaching options that can maximise the financial outcomes from teaching. The inclusion of GP registrars in the teaching model or the supervisor teaching more than one same level learner results in a greater financial benefit. This gain was achieved through a reduction in supervisor teaching time and the sharing of administrative and teaching activities with GP registrars. We also show that a GP teacher who carries a minimal patient load can be a sustainable option for a practice. Further, the costing framework used for the teaching models presented in this study has the ability to be applied to any number of teaching model permutations.

Getting governance right for a sustainable regionalised business model.

The 1998 Ministerial Review of General Practice Training identified several areas for improvement that led to major changes in the provision of general practice training, including the establishment of General Practice Education and Training (GPET) and the regionalisation of training. The regionalised training business model has been in place for nearly 10 years, and several key organisations have been involved in its evolution, including the Australian Government, speciality colleges, GPET and regionalised training providers. Both the college-focused and regionalised-focused models have had some successes. These include recognition and support of general practice as a vocational specialty, increased numbers of junior doctors undertaking placements in general practice, and increased numbers of registrars training in rural areas. This period has also seen changes in the governance and decision-making processes with creation of a new framework that is inclusive of all the key players in the new regionalised training system. The future holds challenges for the regionalised training business model as the general practice education and training landscape becomes more complex. The framework in the current model will provide a base to help meet these challenges and allow for further sustainable expansion.

To teach or not to teach? A cost-benefit analysis of teaching in private general practice.

OBJECTIVE: To identify the financial costs and benefits associated with teaching in private general practice. DESIGN: Cost-benefit analysis of teaching in private general practice across three levels of training--undergraduate medical training, prevocational training and general practice vocational training--using data from a 2007 survey of general practitioners in South Australia. SETTING AND PARTICIPANTS: GPs and practices teaching in association with the Adelaide to Outback GP Training Program or the Discipline of General Practice at the University of Adelaide. MAIN OUTCOME MEASURE: Net financial outcome per week. RESULTS: The net financial outcome of teaching varied across the training levels. Practices incurred a net financial cost from teaching medical students that was statistically significantly different from zero. With respect to vocational training and teaching junior doctors, there were small net financial benefits to practices, although the mean estimates were not statistically significantly different from zero. CONCLUSIONS: This study shows a net financial cost for practices teaching medical students, while at the prevocational and vocational training levels, adequate levels of subsidies and income generated by the trainees help offset the costs of teaching. Our results suggest that a review of subsidies for undergraduate teaching is necessary, particularly as the demand for teaching practices will increase substantially over the next 5 years.

Teaching capacity in general practice: results from a survey of practices and supervisors in South Australia.

OBJECTIVE: To ascertain the teaching load of general practices, the capacity for expansion of general practice-based teaching and the support required to achieve this. DESIGN, SETTING AND PARTICIPANTS: Questionnaire-based survey of general practitioners and practices who were teaching medical students, junior doctors or GP registrars in partnership with the Adelaide to Outback GP Training Program or the Discipline of General Practice at the University of Adelaide in South Australia in 2007. MAIN OUTCOME MEASURES: Current teaching load of general practices; GPs' reasons for teaching; capacity of practices to increase teaching loads; and support required to realise practices' full teaching capacity. RESULTS: In 2007, the 76 practices involved in the survey taught, in total, 326 medical students, 39 junior doctors and 84 GP registrars. Exposing students and doctors to general practice was cited most often by the 194 GP respondents as the reason for teaching. Few practices rated the support payments for teaching as adequate or fairly adequate. A number of practices were able to increase their teaching load within their current levels, with most being able to teach more medical students (39% of practices) or registrars (42% of practices). All practices able to increase their teaching load stated that their capacity to expand was conditional on extra resources, including more physical space, subsidies and teachers. CONCLUSION: Scope exists to increase teaching in the general practices surveyed and is related to the level, or levels, of teaching undertaken by the practices. Targeted support seems essential if practices are to increase their teaching load.

A person-practice-program fit--evaluation of a GP training placement process.

BACKGROUND: The placement of general practice registrars in vocational training practices can be a difficult process if both educational and organisational needs are to be met. METHODS: A telephone survey of 22 registrars and 24 supervisors was conducted to evaluate the placement matching process used by the Adelaide To Outback (A2O) GP Training Program. RESULTS: Overall, registrars and supervisors were satisfied with all components of the placement matching process. The majority of interviewees reported the interview component of the process as being a positive experience. DISCUSSION: The evaluation has shown that the model developed by A2O is successful, allowing input by registrars and supervisors while remaining manageable for the training provider. It is also a transparent and equitable process for all involved and is flexible enough to meet different regional needs. A number of suggested areas for improvement can be integrated easily into the model.

The challenges of teaching in a general practice setting.

An attractive strategy to meet the increasing need for medical education is teaching in community general practice. General practice will be in a position to meet and sustain this need only if various conditions are met, including: Teaching is undertaken in general practice at all levels of medical education (medical student, postgraduate years 1-3 and GP vocational training); Standards and quality of teaching are maintained while the number of sites involved increases; Further Australian research is conducted into innovative models of general practice teaching and their cost-effectiveness; and Appropriate remuneration and infrastructure is available to support practices and general practitioners involved in teaching.

General practice placements for pre-registration junior doctors: adding value to intern education and training.

OBJECTIVE: To examine pre-registration junior doctors' perceptions of the value of a general practice term in their training program. DESIGN, SETTING AND PARTICIPANTS: Semi-structured interviews, in five teaching hospitals in South Australia in 2005, with 20 pre-registration junior doctors (interns) who had completed a general practice term and at least one core term of intern training. MAIN OUTCOME MEASURE: Comparisons between general practice and teaching hospital core training terms with respect to the domains of junior doctor education. RESULTS: Interns perceived general practice and teaching hospital terms to be complementary in their overall training program. The general practice term provided them with knowledge and skills they would not have acquired in the teaching hospital terms alone. One-on-one consulting, initiating patient management, and the opportunity to practise a range of practical and procedural skills were seen to be of particular value. CONCLUSIONS: The general practice and teaching hospital terms both contribute to the training of interns, offering contrasting environments and experiences which enhance interns' professional and personal growth. General practice terms should be considered for inclusion in intern training programs across Australia.